My mental health journey.
What does a woman with a mental-health condition look like? Is she smiling? Is she successful? Is she on medication? For GLAMOUR UK Beauty Editor Lottie Winter, it’s all of the above. Here, she shares her story...
“I can’t swallow water anymore,” I spluttered to my GP, in an attempt to explain the unexplainable: my state of mind. Somehow, I had managed to drive the ten minutes to my local clinic – the first time I’d left my basement flat in south London in a week. My OCD, which I have suffered with since I was a child, had mutated into full-blown agoraphobia, where any trip outdoors resulted in an instant and incapacitating panic attack. My body was shutting down, unable to complete the most basic of human functions. I had only two choices; either try antidepressants or be admitted to hospital. I chose the former.
That was six years ago, a world away from the happy, healthy 28-year-old that people might perceive me to be today. But behind my gloss is a lifetime of mental-health issues – and I’m not alone. A 2017 NHS Digital survey found the number of prescriptions for antidepressants was close to 65 million, up 3.7 million in just one year.
My obsessive-compulsive disorder began aged four. Everything was done in multiples of two; I touched light switches with both hands and chewed in even numbers. If I dropped a crisp during playtime, I’d drop another one to make it even. In my mind, it was all I could do to stop something terrible happening; a modicum of control over an increasingly terrifying world.
OCD is one of the most common mental-health disorders in the UK, according to the charity Mind, and is often combined with experiences of anxiety, panic disorder and depression. I started having panic attacks at 19, and it quickly evolved into depression. It’s almost impossible to accurately describe the feeling of fear washing over you without warning or reason. All I can say is it makes you terrified, both of the world around you and of your own mind.
Later, I was told a panic attack is essentially an adrenaline rush – a fight-or-flight response without any actual danger, so the adrenaline just circulates. In seconds, I’d go from having a normal conversation to being unable to form words. My heart would race, my hands would sweat, my mind would fill with uncontrollable thoughts until I thought I‘d be sick. Then, after half an hour, it would subside, leaving me feeling physically exhausted and mentally crushed. I was ashamed of myself and started avoiding social situations.
I quit my internship at a national newspaper as the panic attacks led to hours of absence and numerous sick days, and I couldn’t begin to adequately explain what was going on. I felt like I didn‘t know myself any more. In desperation, I went to my GP, who immediately put me on weekly sessions of cognitive behavioural therapy (CBT) to try to help me control and manage the attacks.
Between the weekly therapy sessions, my self-inflicted isolation only reinforced my sense of shame, but it meant I didn’t have to try to contain or hide my behaviour. I spent my time performing obsessive-compulsive rituals to safeguard against getting ill. I’d overcook everything, and microwave my plates and bowls to sterilise them.
I wouldn’t eat with my hands. On one occasion when I accidentally touched my tongue, I doused my whole face with antibacterial hand gel, only to end up calling the NHS helpline, paranoid the gel itself would make me sick.
I stopped eating. I stopped sleeping. I stopped drinking. Then that morning (six years ago), after dragging myself to my weekly CBT session, the therapist took one look at me and got my GP, who presented me with the choice of pills or hospital. I chose the pills and was prescribed 100mg of Sertraline, a selective serotonin reuptake inhibitor (SSRI). It‘s one of the most common types of antidepressant, and works by increasing the level of the neurotransmitter serotonin in the brain, which regulates mood and sleeping patterns.
By day three, I was eating and sleeping again. By day seven, the panic attacks had stopped. By the end of the month, I was meeting up with friends. I told them I had a breakdown and was on antidepressants, but they didn’t know the extent of what had happened. I couldn’t bear to explain it to them. Plus, it’s hard to know where to start a story when it hasn’t yet finished.
MASKING THE PROBLEM
The overarching outcome of the Sertraline was complete emotional numbness, but I found it to be blissfully liberating, not alarming as others had warned. After months of living in a heightened state of fear, panic and hopelessness, feeling absolutely nothing came as the ultimate relief. My OCD was still there, but I couldn’t muster up any emotional response to it. It was like a volcano, bubbling under the surface but never erupting.
At the time, my GP was incredibly involved, insisting I return daily for the first week of treatment. But as soon as I was ‘OK’, I slipped through the net. I haven’t had a check-up or even a conversation with a doctor about my dose in more than three years. I request my refills via an online portal, and the signed prescription is emailed to the pharmacy. I’m aware that it might not be the right thing to do, but it’s my decision, because the biggest problem is I don’t want to see a doctor. They might decide I don’t need antidepressants any more and refuse to prescribe them. And for me, that’s a terrifying prospect.
When the Sertraline kicked in, I stopped doing CBT, so I haven’t properly dealt with the underlying issues. I’ve merely pressed pause on them, and I’m paranoid that if I stop taking my medication, everything will play out how it did before. On top of that, I’m physically dependent on them. If I forget to take them, within a few hours I experience debilitating withdrawal symptoms, including dizziness, migraines and extreme tiredness.
“It is not adequate treatment,” says Dr Sarah Davies, a psychologist and psychotherapist. “At best [antidepressants] mask the symptoms, but without considering the root cause and the psychological aspect of the problem, they could do more harm than good.” She couldn’t be more right. A recent study by McMaster University in Canada examined the biological effects of six types of antidepressants, including SSRIs and the other most common group, serotonin-norepinephrine reuptake inhibitors (SNRIs).
Among a long list of side effects, they found that people taking antidepressants had a 14% higher risk of cardiovascular events such as stroke and heart attack, up to 80% of patients experienced sexual dysfunction, and patients were 16% more likely to have a car accident due to reduced attention. With all these risk factors combined, they found that people who take antidepressants have a 33% higher chance of death. It doesn’t improve from a treatment perspective either; an average of 43% of patients on SSRIs relapse after discontinuation.
Had I known this when the doctor initially proposed antidepressants, I may have proceeded differently. At least, I may have seen them as a temporary solution and more actively sought out adequate therapy. Instead, I was assured there were minimal, if any, long-term side effects, so I eagerly accepted them.
“The big problem is that people aren’t aware of their treatment options,” says Dr Davies. “And why would they be, when the quick-fix of antidepressants is offered at such an early stage? In my opinion, psychological therapy, nutrition and lifestyle changes should be the first options, with medication as a last resort.”
A DIFFERENT APPROACH
This lateral approach falls in line with research into the causes of mental-health disorders. “The connection of gut health and brain is well known,” explains Dr Elke Benedetto-Reisch, medical director of world-renowned Austrian wellness clinic Lanserhof. “When we have inflammation in our gut, we are not able to absorb or produce vital nutrients, hormones, chemicals and enzymes that are pivotal in keeping our minds and bodies healthy,” he says. One such example is serotonin;scientists now estimate that up to 90% of the body’s serotonin is produced in the gut. “If your gut is inflamed and not functioning, it will not be able to produce adequate serotonin, triggering insomnia, depression and other mental-health disorders.”
Then there’s therapy itself. Alongside traditional talking therapies such as CBT, which aims to change the way you think by discussing your feelings and offering coping mechanisms, there’s also eye movement desensitisation and reprocessing therapy (EMDR), which retrains the brain’s perception of traumatic events through a series of specific eye movements, and sensorimotor psychotherapy, a holistic therapy working to mend the mind-body connection. These are all available on the NHS, through
a new initiative called IAPT (Improving Access to Psychological Therapies), which can provide a treatment course to best suit your needs.
That said, antidepressants saved my life. I have no doubt about that. I went from being so depressed and tormented that I couldn’t see the point in carrying on, to being able to function without fear, to starting work again and growing my career, to laughing again with the people I love and enjoying being alive. But I’m also facing up to the fact that I don’t want to be on them forever, both for the potential health risks and for myself – I want to be OK without them. While the prospect of coming off them is scary, I’ve heard promising things about ‘tapering’ – decreasing the dose in tiny increments, to eliminate withdrawal symptoms and reduce the risk of relapse.
Dutch medical charity Cinderella Therapeutics provides tapering kits, with measured doses that decrease over a few months. While there’s no such service in the UK, I’m eager to speak to my GP about trying this method and have booked an appointment to discuss it for the first time in three years. I’m also starting therapy again. I’m not sure which type yet as I’m going to work with my therapist to decide what suits me best. Most importantly, I feel positive about my mental health. I don’t feel ashamed anymore and I know help is out there – whether that is in pill form or not.
[Via GLAMOUR UK]